HomeMy WebLinkAbout03- SEPA ChecklistSEPA ENVIRONMENTAL CHECKLIST
Purpose of checklist:
Governmental agencies use this checklist to help determine whether the environmental impacts of your
proposal are significant. This information is also helpful to determine if available avoidance,
minimization or compensatory mitigation measures will address the probable significant impacts or if an
environmental impact statement will be prepared to further analyze the proposal.
Instructions for applicants:
This environmental checklist asks you to describe some basic information about your proposal. Please
answer each question accurately and carefully, to the best of your knowledge. You may need to consult
with an agency specialist or private consultant for some questions. You may use "not applicable" or
"does not apply" only when you can explain why it does not apply and not when the answer is
unknown. You may also attach or incorporate by reference additional studies reports. Complete and
accurate answers to these questions often avoid delays with the SEPA process as well as later in the
decision -making process.
The checklist questions apply to all parts of your proposal, even if you plan to do them over a period of
time or on different parcels of land. Attach any additional information that will help describe your
proposal or its environmental effects. The agency to which you submit this checklist may ask you to
explain your answers or provide additional information reasonably related to determining if there may
be significant adverse impact.
Instructions for Lead Agencies:
Please adjust the format of this template as needed. Additional information may be necessary to
evaluate the existing environment, all interrelated aspects of the proposal and an analysis of adverse
impacts. The checklist is considered the first but not necessarily the only source of information needed
to make an adequate threshold determination. Once a threshold determination is made, the lead
agency is responsible for the completeness and accuracy of the checklist and other supporting
documents.
Use of checklist for nonproject proposals:
For nonproject proposals (such as ordinances, regulations, plans and programs), complete the
applicable parts of sections A and B plus the SUPPLEMENTAL SHEET FOR NONPROJECT ACTIONS (part D).
Please completely answer all questions that apply and note that the words "project," "applicant," and
"property or site" should be read as "proposal," "proponent," and "affected geographic area,"
respectively. The lead agency may exclude (for non -projects) questions in Part B - Environmental
Elements —that do not contribute meaningfully to the analysis of the proposal.
A. Background HELP
1. Name of proposed project, if applicable:
155 Night Owl Rd residence
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2. Name of applicant:
Charles and Heather Southard (landowners)
3. Address and phone number of applicant and contact person:
8087 Lars Dr NE
Bremerton WA 98311
360-917-6281
charles.southardna gmail.com
4. Date checklist prepared:
Checklist reviewed/prepared on 6/26/2022
Project is in the design phase. This SEPA review has been requested as part of a
release from moratorium. The previous property owner obtained permission in December
2017 for a forestry conversion under 76.09 RCW (FPA/N 2615192) that resulted in a timber
harvest of approximately 9 acres in January 2018. The current property owners are seeking a
release from the 6 year moratorium on building approvals/permits through the SEPA
processes defined in 43.21 C RCW.
5. Agency requesting checklist:
Jefferson County Department of Community Development
6. Proposed timing or schedule (including phasing, if applicable):
Anticipate construction beginning in February 2023
7. Do you have any plans for future additions, expansion, or further activity related to or
connected with this proposal? If yes, explain.
No
8. List any environmental information you know about that has been prepared, or will be
prepared, directly related to this proposal.
Geotechnical survey of seismic hazard
Engineered Stormwater Management Plan
9. Do you know whether applications are pending for governmental approvals of other
proposals directly affecting the property covered by your proposal? If yes, explain.
No
10. List any government approvals or permits that will be needed for your proposal, if known.
Building permit
Septic system permit
11. Give brief, complete description of your proposal, including the proposed uses and the
size of the project and site. There are several questions later in this checklist that ask you to
describe certain aspects of your proposal. You do not need to repeat those answers on this
page. (Lead agencies may modify this form to include additional specific information on
project description.)
SEPA Environmental checklist (WAC 197-11-960) July 2016Page 2 of 14
Development of a single family residence and shop in accordance with the attached
site design. Anticipate that this will involve minimal grading and disturbance as delineated in
the attached Stormwater Management plan. The lot is 10.3 acres and this proposal is for the
construction of an approximately 1100 square foot residence, 1200 square foot metal shop
building, and extension of a driveway loop.
12. Location of the proposal. Give sufficient information for a person to understand the
precise location of your proposed project, including a street address, if any, and section,
township, and range, if known. If a proposal would occur over a range of area, provide the
range or boundaries of the site(s). Provide a legal description, site plan, vicinity map, and
topographic map, if reasonably available. While you should submit any plans required by the
agency, you are not required to duplicate maps or detailed plans submitted with any permit
applications related to this checklist.
Address: 155 Night Owl Rd, Port Townsend WA 98386
Parcel: 001334021
Legal Description: S33 T30N R1W TX 56 PARCEL 2 OF SURVEY V16/P116
Zoning: RR20 Rural Residential
B. Environmental Elements HELP
Earth h[ elpl
a. General description of the site:
(circle one): Flat, rolling, hilly, steep slopes, mountainous, other
b. What is the steepest slope on the site (approximate percent slope)?
1.2%
c. What general types of soils are found on the site (for example, clay, sand, gravel, peat,
muck)? If you know the classification of agricultural soils, specify them and note any
agricultural land of long-term commercial significance and whether the proposal results in
removing any of these soils.
IAW attached geotechnical report. Predominantly silt clay loam over coarse sands.
d. Are there surface indications or history of unstable soils in the immediate vicinity? If so,
describe.
No
e. Describe the purpose, type, total area, and approximate quantities and total affected area
of any filling, excavation, and grading proposed. Indicate source of fill.
Per attached Stormwater Management plan. Estimate approximately 480 CY each of
cut and fill.
f. Could erosion occur as a result of clearing, construction, or use? If so, generally describe.
Low probability for erosion as detailed in attached Geotechnical report.
g. About what percent of the site will be covered with impervious surfaces after project
construction (for example, asphalt or buildings)?
SEPA Environmental checklist (WAC 197.11-960) July 2016Page 3 of 14
Approximately 3.5%. Details of current and projected impervious surface are detailed
in Stormwater management plan
h. Proposed measures to reduce or control erosion, or other impacts to the earth, if any:
Erosion mitigations detailed in attached Stormwater management plan.
2. Air hf elp]
a. What types of emissions to the air would result from the proposal during construction,
operation, and maintenance when the project is completed? If any, generally describe and
give approximate quantities if known.
None.
b. Are there any off -site sources of emissions or odor that may affect your proposal? If so,
generally describe.
None.
c. Proposed measures to reduce or control emissions or other impacts to air, if any:
None.
3. Water Lhel
a. Surface Water: h� elpl
1) Is there any surface water body on or in the immediate vicinity of the site (including
year-round and seasonal streams, saltwater, lakes, ponds, wetlands)? If yes, describe
type and provide names. If appropriate, state what stream or river it flows into.
None.
2) Will the project require any work over, in, or adjacent to (within 200 feet) the described
waters? If yes, please describe and attach available plans.
None.
3) Estimate the amount of fill and dredge material that would be placed in or removed
from surface water or wetlands and indicate the area of the site that would be affected.
Indicate the source of fill material.
None.
4) Will the proposal require surface water withdrawals or diversions? Give general
description, purpose, and approximate quantities if known.
No.
5) Does the proposal lie within a 100-year floodplain? If so, note location on the site plan.
No.
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6) Does the proposal involve any discharges of waste materials to surface waters? If so,
describe the type of waste and anticipated volume of discharge.
No.
b. Ground Water: h[ elp]
1) Will groundwater be withdrawn from a well for drinking water or other purposes? If so,
give a general description of the well, proposed uses and approximate quantities
withdrawn from the well. Will water be discharged to groundwater? Give general
description, purpose, and approximate quantities if known.
No.
2) Describe waste material that will be discharged into the ground from septic tanks or
other sources, if any (for example: Domestic sewage; industrial, containing the
following chemicals... ; agricultural; etc.). Describe the general size of the system, the
number of such systems, the number of houses to be served (if applicable), or the
number of animals or humans the system(s) are expected to serve.
Domestic sewage. Proposed septic system design is sufficient for 4-5 bedroom
house but will service a one bedroom home. Additional capacity is designed in to provide an
option for future development if desired.
c. Water runoff (including stormwater):
1) Describe the source of runoff (including storm water) and method of collection
and disposal, if any (include quantities, if known). Where will this water flow?
Will this water flow into other waters? If so, describe.
Per attached Stormwater management plan and checklists
2) Could waste materials enter ground or surface waters? If so, generally describe.
No.
3) Does the proposal alter or otherwise affect drainage patterns in the vicinity of the site? If
so, describe.
Per attached Stormwater management plan and checklists
d. Proposed measures to reduce or control surface, ground, and runoff water, and drainage
pattern impacts, if any:
Per attached Stormwater management plan and checklists
4. Plants hf e
a. Check the types of vegetation found on the site:
SEPA Environmental checklist (WAC 197-11-960) July 2016Page 5 of 14
x deciduous tree: alder, maple, aspen, other
x evergreen tree: fir, cedar, pine, other
x shrubs
x grass
pasture
crop or grain
Orchards, vineyards or other permanent crops.
wet soil plants: cattail, buttercup, bullrush, skunk cabbage, other
water plants: water lily, eelgrass, milfoil, other
other types of vegetation
b. What kind and amount of vegetation will be removed or altered?
Grassy areas in the amounts described in the stormwater management plan and listed
as disturbed areas.
c. List threatened and endangered species known to be on or near the site.
None.
d. Proposed landscaping, use of native plants, or other measures to preserve or enhance
vegetation on the site, if any:
Approximately half to two thirds of the 10 acre property is being replanted with native
evergreens, deciduous trees, and shrubs.
e. List all noxious weeds and invasive species known to be on or near the site.
Canada thistle
5. Animals h[ elp]
a. List any birds and other animals which have been observed on or near the site or are
known to be on or near the site.
Examples include:
birds: hawk, heron, eagle, songbirds, other: finches
mammals: deer, bear, elk, beaver, other:
fish: bass, salmon, trout, herring, shellfish, other
b. List any threatened and endangered species known to be on or near the site.
None.
c. Is the site part of a migration route? If so, explain.
No.
d. Proposed measures to preserve or enhance wildlife, if any:
None
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e. List any invasive animal species known to be on or near the site.
None
6. Energy and Natural Resources hf e
a. What kinds of energy (electric, natural gas, oil, wood stove, solar) will be used to meet
the completed project's energy needs? Describe whether it will be used for heating,
manufacturing, etc.
PUD Electric for shop and single family residence to include heating. Single family
residence to include a wood stove for backup heating.
b. Would your project affect the potential use of solar energy by adjacent properties?
If so, generally describe.
No.
c. What kinds of energy conservation features are included in the plans of this proposal?
List other proposed measures to reduce or control energy impacts, if any:
Passive solar design.
7. Environmental Health h[ elpl
a. Are there any environmental health hazards, including exposure to toxic chemicals, risk
of fire and explosion, spill, or hazardous waste, that could occur as a result of this
proposal?
If so, describe.
No
1) Describe any known or possible contamination at the site from present or past uses.
None
2) Describe existing hazardous chemicals/conditions that might affect project
development and design. This includes underground hazardous liquid and gas
transmission pipelines located within the project area and in the vicinity.
None
3) Describe any toxic or hazardous chemicals that might be stored, used, or produced
during the project's development or construction, or at any time during the operating
life of the project.
None
4) Describe special emergency services that might be required.
None
5) Proposed measures to reduce or control environmental health hazards, if any:
None
SEPA Environmental checklist (WAC 197.11.960) July 2016Page 7 of 14
b. Noise
1) What types of noise exist in the area which may affect your project (for example:
traffic, equipment, operation, other)?
None
2) What types and levels of noise would be created by or associated with the project on a
short-term or a long-term basis (for example: traffic, construction, operation, other)? Indi-
cate what hours noise would come from the site.
Construction noise during the construction phase from 0700-1700.
3) Proposed measures to reduce or control noise impacts, if any:
None
8. Land and Shoreline Use 1tpjp1
a. What is the current use of the site and adjacent properties? Will the proposal affect current
land uses on nearby or adjacent properties? If so, describe.
The property and all adjacent properties are zoned Rural Residential 20. This project
will not affect land use on nearby or adjacent properties.
b. Has the project site been used as working farmlands or working forest lands? If so,
describe. How much agricultural or forest land of long-term commercial significance will be
converted to other uses as a result of the proposal, if any? If resource lands have not been
designated, how many acres in farmland or forest land tax status will be converted to
nonfarm or nonforest use?
Not designated as resource lands. A maximum of 3 acres will be converted to
nonforest use.
1) Will the proposal affect or be affected by surrounding working farm or forest land normal
business operations, such as oversize equipment access, the application of pesticides,
tilling, and harvesting? If so, how:
Project will not affect land use of surrounding properties.
c. Describe any structures on the site.
Per the site plan, property contains a 192 sgft shed and 525 sgft barn.
d. Will any structures be demolished? If so, what?
No
e. What is the current zoning classification of the site?
Rural Residential - 20
f. What is the current comprehensive plan designation of the site?
Rural Residential - 20
g. If applicable, what is the current shoreline master program designation of the site?
Not applicable
SEPA Environmental checklist (WAC 197-11-960) July 2016Page 8 of 14
Has any part of the site been classified as a critical area by the city or county? If so,
specify.
Site designated as seismic hazard. Attached geotechnical report assesses the hazard
as low. Site also designated as Critical Aquifer Recharge Area. A DNR stream is listed on
county GIS maps, however, the attached email chain shows that the state forester has
determined that the stream does not exist on the property.
i. Approximately how many people would reside or work in the completed project?
Two
j. Approximately how many people would the completed project displace?
None
k. Proposed measures to avoid or reduce displacement impacts, if any:
None
L. Proposed measures to ensure the proposal is compatible with existing and projected land
uses and plans, if any:
None
m. Proposed measures to reduce or control impacts to agricultural and forest lands of
long-term commercial significance, if any:
Replanting -5-7 acres as forest
9. Housing hf glp
a. Approximately how many units would be provided, if any? Indicate whether high, mid-
dle, or low-income housing.
One middle income single family residence
b. Approximately how many units, if any, would be eliminated? Indicate whether high,
middle, or low-income housing.
None
c. Proposed measures to reduce or control housing impacts, if any:
None
10. Aesthetics hI elW
a. What is the tallest height of any proposed structure(s), not including antennas; what is
the principal exterior building material(s) proposed?
SFR - 20' height, cedar siding metal roof
Shop - metal siding and roof
b. What views in the immediate vicinity would be altered or obstructed?
None
SEPA Environmental checklist (WAC 197-11-960) July 2016Page 9 of 14
b. Proposed measures to reduce or control aesthetic impacts, if any:
None
11. Light and Glare LLelp
a. What type of light or glare will the proposal produce? What time of day would it mainly
occur?
Project would not produce any significant light or glare.
b. Could light or glare from the finished project be a safety hazard or interfere with views?
No
c. What existing off -site sources of light or glare may affect your proposal?
None
d. Proposed measures to reduce or control light and glare impacts, if any:
None
12. Recreation hj elp�
a. What designated and informal recreational opportunities are in the immediate vicinity?
None
b. Would the proposed project displace any existing recreational uses? If so, describe.
None
c. Proposed measures to reduce or control impacts on recreation, including recreation
opportunities to be provided by the project or applicant, if any:
None
13. Historic and cultural preservation h[ elpj
a. Are there any buildings, structures, or sites, located on or near the site that are over 45
years old listed in or eligible for listing in national, state, or local preservation registers ? If
so, specifically describe.
No.
b. Are there any landmarks, features, or other evidence of Indian or historic use or
occupation? This may include human burials or old cemeteries. Are there any material
evidence, artifacts, or areas of cultural importance on or near the site? Please list any
professional studies conducted at the site to identify such resources.
No
c. Describe the methods used to assess the potential impacts to cultural and historic
resources on or near the project site. Examples include consultation with tribes and the
SEPA Environmental checklist (WAC 197-11-960) July 2016Page 10 of 14
department of archeology and historic preservation, archaeological surveys, historic maps,
GIS data, etc.
Publicly available GIS data
d. Proposed measures to avoid, minimize, or compensate for loss, changes to, and
disturbance to resources. Please include plans for the above and any permits that may be
required.
None
14. Transportation h�elgl
a. Identify public streets and highways serving the site or affected geographic area and
describe proposed access to the existing street system. Show on site plans, if any.
Nearest public street is Four Corners Rd and is 750' away accessible via an existing
private road (Night Owl Rd.).
b. Is the site or affected geographic area currently served by public transit? If so, generally
describe. If not, what is the approximate distance to the nearest transit stop?
Nearest bus stop is at the transit center, approximately 3,500 ft away.
c. How many additional parking spaces would the completed project or non -project proposal
have? How many would the project or proposal eliminate?
Two. None.
d. Will the proposal require any new or improvements to existing roads, streets, pedestrian,
bicycle or state transportation facilities, not including driveways? If so, generally describe
(indicate whether public or private).
No.
e. Will the project or proposal use (or occur in the immediate vicinity of) water, rail, or air
transportation? If so, generally describe.
No.
f. How many vehicular trips per day would be generated by the completed project or
proposal? If known, indicate when peak volumes would occur and what percentage of the
volume would be trucks (such as commercial and nonpassenger vehicles). What data or
transportation models were used to make these estimates?
Approximately one vehicular trip per day would be generated by this proposal.
Estimate is based on actual data for future residents.
g. Will the proposal interfere with, affect or be affected by the movement of agricultural and
forest products on roads or streets in the area? If so, generally describe.
No
h. Proposed measures to reduce or control transportation impacts, if any:
None
SEPA Environmental checklist (WAC 197-11-960) July 2016Page 11 of 14
15. Public Services hj eM
a. Would the project result in an increased need for public services (for example: fire
protection, police protection, public transit, health care, schools, other)? If so, generally
describe.
Increase in public services required for an additional single family residence.
b. Proposed measures to reduce or control direct impacts on public services, if any.
None.
16. Utilities hI elpl
a. Circle utilities currently available at the site:
electricity, natural gas, water, refuse service, telephone, sanitary sewer, septic system,
other
None.
b. Describe the utilities that are proposed for the project, the utility providing the service,
and the general construction activities on the site or in the immediate vicinity which might
be needed.
Water, electric, and internet provided by Jefferson County PUD.
C. Signature HELP
The above answers are true and complete to the best of my knowledge
lead agency is relying n them to m is decision.
Signature:
Name of signee ��,�r �/��>�•
Position and Agency/Organization
Date Submitted:
D. Supplemental sheet for nonproject actions HELP
(IT IS NOT NECESSARY to use this sheet for project actions)
I understand that the
Because these questions are very general, it may be helpful to read them in
conjunction
with the list of the elements of the environment.
When answering these questions, be aware of the extent the proposal, or the types of
activities likely to result from the proposal, would affect the item at a greater intensity or
SEPA Environmental checklist (WAC 197-11.960) July 2016Page 12 of 14
at a faster rate than if the proposal were not implemented. Respond briefly and in
general terms.
1. How would the proposal be likely to increase discharge to water; emissions to air; pro-
duction, storage, or release of toxic or hazardous substances; or production of noise?
Proposed measures to avoid or reduce such increases are:
2. How would the proposal be likely to affect plants, animals, fish, or marine life?
Proposed measures to protect or conserve plants, animals, fish, or marine life are:
3. How would the proposal be likely to deplete energy or natural resources?
Proposed measures to protect or conserve energy and natural resources are:
4. How would the proposal be likely to use or affect environmentally sensitive areas or
areas designated (or eligible or under study) for governmental protection; such as parks,
wilderness, wild and scenic rivers, threatened or endangered species habitat, historic or
cultural sites, wetlands, floodplains, or prime farmlands?
Proposed measures to protect such resources or to avoid or reduce impacts are:
5. How would the proposal be likely to affect land and shoreline use, including whether it
would allow or encourage land or shoreline uses incompatible with existing plans?
Proposed measures to avoid or reduce shoreline and land use impacts are:
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6. How would the proposal be likely to increase demands on transportation or public
services and utilities?
Proposed measures to reduce or respond to such demand(s) are:
7. Identify, if possible, whether the proposal may conflict with local, state, or federal laws or
requirements for the protection of the environment.
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